War trauma PTSD Post Traumatic Stress Disorder Acute Stress Disorder

Learning from my Clients about War Trauma

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Learning from my Clients about War Trauma

As the war in Ukraine continues I think about the many nationalities I met in my practice over the years. Croatian, Ethiopian, French, English, Mexican, Canadian, Indian, Native American, Polish, Romanian, Chinese, Japanese, Pilipino, and probably more I'm not remembering right now. Being a trauma specialist some came to me with the long term after effects of having their homeland invaded, bombs dropping and the terror of war. I find my thoughts rest on a Polish man I met who suffered from anxiety I'm certain had roots in his childhood when Poland was being invaded by fascists. There didn't seem to be any other explanation so we spoke quite a bit about his experience during that time in his life.

It was my curiosity that got me into becoming a trauma specialist. I remember thinking, "how the hell do people survive psychologically through life threatening experiences?!?!?" The diagnosis of Post Traumatic Stress Disorder came about when our military returned from Viet Nam. I am the age where Viet Nam Veterans have been in the age group I dated. In the 60s and 70s we began to understand some of the misconceptions with which war survivors were being treated up until that time.

PTSD before it became a diagnosis was referred to by several names. The strangest is "Railway Spine" which came after a railway accident in the 1800s in England. "Soldier's Heart" in 1900s In 1916 "Battle Fatigue". In WWII "Shell Shock" and "Battle Fatigue" were used and it was seen as a wound rather than an illness as it should be considered. "Shell Shock" became known as referring to "terrifying events outside the normal range of human experience". The first time it was written about in a medical journal was in The Lancet on February 2nd 1918 written by Captain W.H.R. Rivers his article titled "On the Repression of War Experience." He wrote, "The process of repression does not cease when some shock or strain has removed the soldier from the scene of warfare, but it may take an active part in the maintenance of the neurosis." The pattern of symptoms was beginning to be recognized.

PTSD was being called "stress response syndrome" and described as being cause but in the aftermath of the Viet Nam War most likely in order to not take responsibility for the psychological wound by telling the men if they still had symptoms after 6 months they were told it had to be a "pre-existing" condition and not service connected. This resulted in a lot of "walking wounded" and probably contributed to the high suicide rate suffered by Vietnam Veterans of that time. They were basically told their war experiences were not the cause of their nightmares and flashbacks to the scenes of war. For too long victims have been blamed for their own symptoms and told to get over it. Nowhere is that more true than in the military with it's buck up and get over it attitude in a hurry to get soldiers back in the fight. Fortunately since Iraq and Afghanistan some high ranking officers have spoken out about their PTSD and getting treatment. 

Today in psychology we define trauma as "a threat to life or bodily integrity". You don't have to have experienced war to end up with PTSD. I am all for de-stigmatizing it. Some have suggested exchanging disorder back to syndrome. Disorder seems to imply that there is something wrong with you. And many sufferers think that is the case. But it is not about you, it is about what happened to you. No one wants the symptoms or PTSD or what it morphs into, depression, anxiety, panic attacks to name a few. When you are asked why are you still talking about this, the best reply is "because it is still affecting my life." Friends and family of those with PTSD still seem to think it is a weakness and they need to just pull yourself up by your bootstraps and forget it every happened. FORGET IT EVER HAPPENED?!?!? That's not the problem, any of my trauma clients would love to be able to forget it ever happened, that I promise you. I have talked to family member and friends and explained PTSD to them, the symptoms, how it affects people, the mood swings, etc. But they still say the same hurtful things to the client. As has been said, it isn't that they won't let go of the past, it's that the past won't let go of them. I've tried to help them understand but it seems like friends and family decide to be clueless as to how to be helpful instead of hurtful.

What we can do is get people into treatment ASAP. It is much easier to treat when people come in right away. But there are a number of barriers to this. First off if it was life threatening people feel relieved to be alive they don't feel the need. In the first 30 days it is called "Acute Stress Disorder" and in many cases the symptoms don't last beyond 30 days. One of the symptoms is called avoidance. People avoid anything that reminds them of the trauma which includes talking about it. Yet talking about it is exactly what needs to happen. So when it starts to bother them they might make an appointment but as the date gets closer they feel more and more anxious and then when they cancel or no show they feel a relief which sets up a cycle of avoidance. 

I have seen PTSD completely resolve in 10 sessions if the clients comes in soon after the trauma. They also need to attend therapy on a regular basis, at least weekly. Again avoidance can prevent that. However even if it is years since the trauma there can still be a lot of healing, but it is unlikely to completely resolve unless the client is extremely diligent in working on it. With avoidance that is rarely the case. 

And it can be prevented altogether if we stop having wars and violent crime, that would be my choice but that's unfortunately not going to happen.